Provider Demographics
NPI:1679925416
Name:MAKI, LAUREN
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:MAKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:
Other - Last Name:BENOIT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:555 MANNING ST
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:MA
Mailing Address - Zip Code:01522-1540
Mailing Address - Country:US
Mailing Address - Phone:508-769-8987
Mailing Address - Fax:
Practice Address - Street 1:237 MILLBURY ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01610-2177
Practice Address - Country:US
Practice Address - Phone:508-755-1228
Practice Address - Fax:508-754-0668
Is Sole Proprietor?:No
Enumeration Date:2016-07-05
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist